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What messages are parents and the school sending when we are rewarding coming to school 100% of days? The message is this: We want you at school no matter what it takes. 

About a year ago, I attended a graduation for an elementary school in which students received recognition and awards for perfect attendance. Granted, the two students who won received bicycles (yah for promoting a health recognition gift versus a Pizza Hut gift card), however I want to address how this simple recognition is incredibly inequitable and potentially harmful to many students.

Students who have perfect attendance are more likely to be engaged in school and do well academically- sure! Of course. However, many students can't achieve this for valid reasons. My biggest concern for those with perfect attendance is this... how many students strive for this recognition and refuse to be absent when truly sick? How many students come to school when they legitimately need a day off? How many come to school when contagious? What messages are parents and the school sending when we are rewarding coming to school 100% of days? The message is this: We want you at school no matter what it takes.

I understand that it also sends the message that attendance is important, however, there are other ways of doing this without 13% of students who are chronically absent feeling marginalized as a result of a parent issue, health issue, child care issue, homeless issue, addiction issue at home. Rewarding for attendance almost punishes and stigmatizes students who in many cases don't have control over their attendance!

Based on the most recent national data, about 13 percent of students miss 15 or more school days.1 Chronic absenteeism is related to a variety of issues. Chronic absenteeism is defined differently in each state, however, research suggests that missing 10 percent or more school days can affect student outcomes.2

The McKinney-Vento Act defines homeless children and youths as individuals who lack a fixed, regular, and adequate nighttime residence. This includes:

Children and youths who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason

Children and youths who may be living in motels, hotels, trailer parks, shelters, or awaiting foster care placement

Children and youths who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings

Children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings, or

Migratory children who qualify as homeless because they are children who are living in similar circumstances listed above.

These students are more likely to be chronically absent, as you can imagine. Other criteria that increase risk of chronic absenteeism include: Students who are hungry, living through toxic divorces or have chronic illnesses. Students with unmanaged asthma, for example, are more likely to be absent. If a student does not have health insurance or is from an undocumented family they are less likely to go to a doctor. Students who have vision, hearing and oral health problems that haven't been diagnosed are more likely to be absent as well. If a school is fortunate enough to have a school nurse who implements regular screenings on some of these issues- that does increase attendance rates since these health concerns may be caught and managed. However, nationally, our school nurse situation (ratio of a school nurse to student and even a full time nurse in each school is rare) is pretty depressing.

My suggestion is that schools consider spending the resources, time and effort, including collecting the data to inform and determine why students are chronically absent at their school, develop a school-wide strategic plan around it and implement some evidence-based strategies to create equity around attendance and presenteeism. However, consider two things: Don't reward for 100%/Perfect attendance (lower that percent) and do it in a way creates an inclusive environment, not a disparate one.

Media literacy refers to the ability to check if your source is creditable and ensure the information you are reading is accurate and based in science. And, it’s becoming increasingly more important. The skill of media literacy should be applied to all information you read on the internet but often people tend to believe whatever they read, credible or not. We often address “fake” news/information in adult populations, but what about adolescents? Young teens and teens are even less aware of the need to check the credibility of the information they are receiving.

I recently read the article “Why Can’t We Just Have Sex?”: An Analysis of Anonymous Questions About Sex Asked by Ninth Graders, this article focused on urban 9th grade students of mostly Latino and African American decent (N=645). Students were asked to write down any question about sex they would like to have answered during their sex education course. While this article shined light on what adolescent students want to learn during a comprehensive sex education course, it had some important and shocking unintentional results (Pariera and McCormack, 2017). For example,- The number of young people who claiming to have learned about birth control has DECREASED in recent years (Pariera and McCormack, 2017);- One third of all educators with the task of teaching sex education do not receive any special training (Pariera and McCormack, 2017);- Less than half of the young people say they learned how to use a condom or information on where to get birth control (Pariera and McCormack, 2017); and- 37% of all questions asked indicated some form of misinformation (Pariera and McCormack, 2017).

A 2004 report found that 11 of the 13 common used sex education curricula were inaccurate, containing falsehoods about HIV, abortion and birth control (Pariera and McCormack, 2017). Students are leaving sex education courses with no skills applicable to real life scenarios, they are often also not able to differentiate between real and false information and have no functional skills.

Youth in the United States are expected to wade through countless encounters with false information and come out with all the right information. That seems unreasonable when modern adults are not able to accomplish the same task. With recent studies showing that sex education curriculum problems are impeding student access to accurate and practical information that could be beneficial to them (Pariera and McCormack, 2017). It is time to begin equipping students with the ability to differentiate between factual and false information, it also time to begin funding specialized training for educators who will be teaching sex education courses. Equipping educators with media literacy skills and the ability to address and correct misconceptions from students.

Source:Pariera, K. and McCormack, T. (2017). “Why Can't We Just Have Sex?”: An Analysis of Anonymous Questions About Sex Asked by Ninth Graders. American Journal of Sexuality Education, 12(3), pp.277-296.

I recently worked with the Oregon School Based Health Alliance to develop and facilitate a training to build capacity for staff that coordinate youth action councils or school health action councils (YACs or SHACs). The work is funded through the Oregon Health Authority’s School Based Health Center (SBHC) State Program Office. The funding is focused on mental health, and each YAC/SHAC works to raise awareness of their school’s school-based health center and implement a participatory action research project around mental health. Coordinators from across Oregon came together for two days to learn, share, and connect! They brought so much wisdom, energy and great strategies for working alongside young people.

What are Youth-Adult Partnerships?Youth- adult partnerships are about sharing power with young people. It occurs along a spectrum from zero youth involvement (they are a “vessel”) to total youth control (like youth led grass roots organizing). There’s a sweet spot in the middle where adults and youth share power. Adults may provide the connections, opportunities to build skills (like public speaking, research, writing), help keep everyone on the same page and organized, and help navigate obstacles but young people are making the decisions and leading the work. If you are interested in learning more about youth-adult partnerships, check out a webinar I co-facilitated with Haylee, the Student Health Advocate Coach for the Oregon School Based Health Alliance here http://osbha.org/blogs/ashleyosbhaorg/intro-youth-adult-partnerships-webinar .

Below are some of the best practices for building youth-adult partnerships adapted from research and practice, as well as some reflections from the training.

1) Pay attention to logistics and group dynamics. Young people have complicated lives and they need flexibility. Ensure you have many different ways young people can be involved that elevate different skills, interests and personalities. For example, you might have someone who is interested in graphic design but can’t make your meetings. Could they work on marketing materials or an infographic and keep connected through communication platforms like GroupMe, SLACK, or Google Hangout? How often does the group meet? Are there barriers that keep a diverse array of young people from being able to participate (like transportation)?

2) Creating opportunities for reflection. These can be formal or informal, and individually or as a group. Some of the benefits of youth adult partnerships come from young people creating connections with a supportive adult, their peers, and having a stronger connection to their community or school. Holding space for reflection and relationship building is critical (and particularly related to number 3).

3) Affirmatively address issues of role and power. This is a BIG one, and one that our training participants agreed could have been the whole focus of our training! Many of the “systems” (schools, local or state government, etc.) are not built to effectively partner with young people. Plus, many adults in those systems are probably not used to working with young people in a partnership capacity. As young people work together to create change in their community they will inevitably: 1) run into obstacles that will delay or derail their plans and 2) confront issues of inequality, oppression, stigma or “isms”. It’s vital that young people are supported to identify the power brokers or points of leverage in their system/community and get them on board. When obstacles do arise, the coordinator or adult ally has to hold space to be able to help facilitate the likely anger and frustration into a new path forward. Having a strong group process, team building opportunities, and time for reflection with thoughtful facilitation can help support young people as they critically examine all the things that influence them, their families, neighborhood and community.

For more information about building youth-adult partnerships or participatory action research with young people, you may contact Liz at liz@cairnguidance.com

How can our tobacco prevention public health partners support youth tobacco prevention and cessation? In a couple of weeks, I have the opportunity to work with 75 Kentucky county tobacco coordinators. My hope is to work with them on some visioning and discuss evidence-based strategies when doing this work. I won't have time to focus specifically on adolescent health, as the day's focus is on all of Kentucky's population, however, wanted to suggest some ideas for anyone working on youth tobacco prevention/intervention! Here goes...

1. Work with one district that just adopted a strong comprehensive policy that is ready to go from awareness (policy is there, but only awareness of it exists) to implementation. Content support may include: Systems Thinking Systems Changing Simulation, Tobacco Policy, School/District Wellness Councils, School Health Index completion to drive action planning, review local YRBS data around tobacco, analyze inventory/Index results and prioritize, evidence-based tobacco prevention programs and practices, action planning, implementation of action plans, evaluation and sustainability work.

Photos are submitted by a certain date and state convenes a group of experts to judge photos, using a scoring rubric that has been developed and shared as contest rules/process is distributed.Use some dollars to offer prize money to 3 winners. Contest is an opportunity to partner with school related arts, school health and state and local tobacco prevention partners. It’s also an opportunity to do some advocacy for tobacco prevention. An evening event may be held where top 10 photos are displayed and invite partners, youth, etc.

Analyze and assess all tobacco policies from all districts in State/region and score them using a rubric based in best practice. Create a statewide map with a key marking districts as gold, silver and bronze. Bring that map to training events and administrator and school board conferences and share via social media.

4. Offer Tobacco Prevention Curricula Training events to two districts that apply. Application will include a readiness checklist. Trainer facilitates a one day training on Foundations of Health Education and participants will use CDCs HECAT to select an evidence based or promising practice tobacco curriculum that best fits their district’s needs. Trainer supports district presentation to their school board for adoption of this curriculum, if applicable. Once adopted, a 2-day tobacco prevention curriculum training on the program selected will cover the following goals and objectives.

5. Host a full-day Systems Thinking Systems Changing™ simulation training with youth (middle and high school-aged) and policy makers/education leaders. Systems Thinking/Systems Changing™ is used by teams in workshop settings to experience what it takes to make effective systemic change in schools. It provides opportunities for youth, educators, school boards and councils, leadership teams, school administrators, educational consultants and reformers about the structures and strategies that schools need to be continuously improving learning organizations that are the best they can be. It supports doing systems change in schools, including policy creation, revision and implementation.

6.Facilitate positive youth development action research project around Tobacco Prevention. Includes 3 non-consecutive full day workshops.

With so little time to teach health education and so many content areas being added annually, health education instruction is not as not as effective as it could be. Meth bills, opioid bills, bullying prevention bills... is that really the answer? Putting more pressure on health teachers to teach more content?

Let me be honest... students are getting severely minimal health education to begin with. Like, embarrassingly small amounts of time focusing on one of the most important areas of one's life- health & well-being. According to Centers for Disease Control and Prevention School Health Profiles Survey, there is a large discrepancy of secondary schools that taught a required health education course 6th-12th grades. Some states do not require a credit in health education for graduation and many middle school students receive less than 9 weeks of health education throughout their middle school tenure.

As more and more state bills are introduced to intervene on public health crises, more content is added to the health teachers' plate. A plate that is typically full to begin with since there isn't enough time allotted to the content area.

To add to the lack of time for health education, many health teachers are not highly qualified/certified and in some cases, the science or PE teacher is asked to teach health, whether or not they have a degree or certification in the area. Non-qualified teachers teaching health are less likely to teach certain subjects (lack of comfort or knowledge on finding strong materials & resources) and many have not had training in answering difficult questions, skills-based health education pedagogy and the evidence-based practices in the field.

Teaching a 2 day unit on promotion of healthy eating to expect that students gain the functional information and skills they need to eat breakfast everyday, select nutrient-rich snack and meals, drink water, eat fruits and veggies is not realistic. A math teacher doesn't spend two days on the addition unit and move on. There is a logical progression and application over time that is integrated in through hours of study. Health education should consist of units that are taught specifically to address concerning data points of student health behavior and to help support the maintenance of health promoting behaviors. Meaning, 2-day units aren't going to cut it. But, if you haven't had strong professional development in the content area and you aren't even a certified health teacher, you might not know that isn't effective. Units should be a couple weeks in length and I believe they should be more focused on skill-building than content anyway. Most legislative bills focus on content without any specific skill-building aspects aligned to health education.

I'm not saying passing legislative bills isn't the way to go. It really is a great opportunity. But, I'd like legislators and even public health content specialists passionate about addressing a public health crisis to understand health education pedagogy and the National Health Standards of which ONE is content specific, and SEVEN are skills-based (analyzing influences, accessing information, interpersonal communication, decision making, goal setting, self-management and advocacy).

Bills that legislators might introduce that will help health education, and therefore prevent drug use and other public health crisis might have language that includes something like...

Comprehensive health education K-12 is taught sequentially through a locally develop scope and sequence aligned to the state content standards and informed by local data driven decisions on adolescent health behaviors. The minimum minute requirements are:

Elementary School: 45 minutes/week

Middle School: 90 minutes/week

High School: 90 minutes/week

Health education should be skills-focused in which students are spending 75% of instructional time within a course on practicing and demonstrating the seven National Health Education Skill Standards.

Health teachers should be highly qualified to teach health education.

Health teachers should have access to content-specific professional development opportunities at least twice a year.

The entire K-12 content area or discipline of health education needs a new identity. My generation and older remembers health ed as the class where you learned to Just Say No, or that having sex means you'll have blisters on your genitalia. We remember reading Chapter 11 on smoking cigarettes and answering 5 questions at the end of the chapter to assess our knowledge that smoking is bad.

Unfortunately, health education has continued to be branded in peoples' minds as drug ed and sex ed. Those embarrassing activities or conversations that felt uncomfortable and forced. And sadly, due to a lack of professional development and support to people teaching health, how health was taught 30 years ago is still happening today.

If the goal of K-12 school health education is health literacy, the ability for students to use, analyze, interpret, access, advocate for resources, information and products that are health-enhancing, we still have a long way to go. Many of the textbooks, activities and instructional methods used are about teaching content and it's time we leave those practices behind.

An article on the Teen Brain: Behavior, Problem Solving, and Decision Making by the American Academy of Child and Adolescent Psychiatry shares that based on the stage of their brain development, adolescents are more likely to:-act on impulse-misread or misinterpret social cues and emotions-get into accidents of all kinds-get involved in fights-engage in dangerous or risky behavior

Adolescents are less likely to:-think before they act-pause to consider the consequences of their actions-change their dangerous or inappropriate behaviors

Some health teachers aren't aware of the research, nor are organizations, content specialists and non-profits that are writing content for health education. This is not to point blame, but rather, due to the lack of knowledge and professional development support. Much of the curriculum out there is still based on assuming youth can make great decisions every time if they just read about the risks and dangers.

Health education has gone through quite a paradigm shift. Teachers are just catching up.

Health education has gone through quite a paradigm shift. Teachers are just catching up. Understanding the adolescent brain is one piece of research that has been helpful, but another shift is skills-based instruction, learning, demonstrating and assessment. We've started to ask better questions...

Does answering 5 questions correctly at the end of a tobacco unit mean that the student will have excellent refusal skills when offered a cigarette?

Do students need to know the names of the germs in order to effectively wash their hands?

Do students need to memorize the 206 bones of the body in order to fit a helmet properly, wear elbow/knee pads and wear a seatbelt consistently and correctly 100% of the time while riding in a vehicle?

Having the skill to memorize and recite Martin Luther King's exact words doesn't mean you understand the Civil Rights Movement. The answer is NO! to all of these questions above. If our goal is health literacy, every lesson, activity, demonstration, video, assessment should lead to healthy behavior outcomes (HBOs). And, if it doesn't- let it go! (You can find a list of HBOs in the HECAT, in the boxes on the front page of each module.

So, as we started to focus on skills in the classroom, we have also started to question what content is important? Benes and Alperin define functional information as information that is useable, applicable, and relevant. It is not arbitrary, traditional, or extensive. Functional information is the context in which the skills will be taught and the base for students’ developing functional knowledge. (Benes & Alperin, 2016)

I know, many of you are saying, I do skills-based. But, then I hear... it's important for a middle school student to know the body systems. To an extent, yes. But students aren't all going into pre-med in high school. In order to keep your heart healthy, you don't need to be able to diagram it, but rather, what behaviors help keep it healthy? And, how do you set some goals around those behaviors? What do students really need to know and demonstrate in order to lead to a healthy behavior outcome? Not much, actually. They need to practice skills, and be able to master those skills.

RMC Health's Health Skills Models define what mastery looks like for each of the skill standards by grade level band. For example, for Advocacy, high school students should: • Students are able to identify a health-enhancing behavior using peer and societal norms.• Students are able to demonstrate how they can influence and support others into making positive health choices.• Students are able to work cooperatively with a group, analyze and solve various barriers they may encounter• Students are able to adapt the health message to a specific audience.• Students are able to reflect on the process and make adjustments as needed.

State Departments of Education are shifting to creating State Content Standards that are more focused on the skills and what mastery looks like for the skills and less on content, leaving that to local decision making. And, I agree with that. I think districts should spend the time reviewing any local data they can get their hands on and using student behavior data to drive/inform their local scope and sequences. Write down the concerning data points and determine which HECAT HBOs will address the concerning points. Which skill and knowledge expectations from the HECAT modules will address those student risk behaviors? Limit the number of units you teach. In fact, I suggest calling units the skills, not the content areas.

I believe instead of teaching mental/emotional health promotion in September, you teach accessing information with 2-3 content areas as context to the skill. And, you move on to another skill... maybe goal setting and you teach 2-3 content areas for context. The district scope and sequence process is guided by those initial concerning data points.

If we go this way, truly, it means we need to re-brand our discipline. Our education leaders still think of drug ed and sex ed. Many do not understand that the skills in health education are life skills (analyzing influences, accessing information, interpersonal communication, goal setting, decision making, self management and advocacy). At multiple events, I have heard from businesses and employers that they expect the people they hire to have communication skills, decision making skills, negotiation skills... that is HEALTH EDUCATION! But, nobody recognizes it, because we still have health educators that aren't here yet. They aren't teaching skills-based, so our field continues to be stereotyped that it's the same it was 30 years ago.

I want to re-brand our field. This is the first of many health education posts in this series. Upcoming topics include:

The #MeToo movement has shown the extent to which acts of rape, sexual violence and sexual misconduct permeate the lives of countless women, as well the people and institutions that allow it to perpetuate like an “open secret”. Last month, the news of allegations of sexual misconduct against Asis Ansari added a new dimension to the #MeToo discourse. There was a debate about whether the actions of Asis belonged in the same conversation as the actions of Harvey Weinstein or Larry Nassar. But folks working in the field of sexuality education knew that it did.

While I was consuming all of this in my news feed, I just kept thinking to myself, “This is why we need more comprehensive sexuality education in every school in every town starting from preschool through higher education!” According to the Guttmacher Institute, fewer than half the states require schools to include the topic of “avoiding coercion” as part of a sexuality education program and similarly, a majority don’t require discussion of healthy relationships. But teaching young people about healthy relationships is the primary prevention for sexual violence because it’s centered on breaking down gender stereotypes, setting healthy boundaries, communication, and that consent is more than just “not hearing no”.

There are states and school districts that are using this as an opportunity to strengthen laws and policies around sexuality education. The Sexuality Information and Education Council of the United States (SIECUS) has developed a toolkit to support educators to advocate for policies that support comprehensive sexuality education. They also created the partner #TeachThem movement to build on the awareness that #MeToo has brought to the need for stronger comprehensive sexuality education. But even states with strong policies struggle with implementation due to a lack of funding for professional development for teachers and administrators.

This is why I’m so proud to be supporting a school district with funding from Advocates for Youth to develop a sexuality education plan of instruction K-12 inclusive of policy, scope and sequence and training/professional development. Earlier this month we held a meeting with folks representing: education, public health and child welfare at the state level; school administrators; district staff; county public health; community based organizations that provide culturally specific sexuality education; university; LGTBQ rights; and sexual assault/violence prevention. The group came together to critique the first draft of a district sexuality education policy. We envisioned a policy that codifies instruction that is not just developmentally appropriate and science-based, but inclusive and trauma-informed. A policy where school level data are used to guide instruction, and teachers are enthusiastic and equipped to teach sexuality education through strong professional development and support from an incredible network of community partners. There is so much more work to do, but I left this meeting filled with energy and hope.

I salute these and other professionals, sexuality educators, young people, teachers, administrators and advocates across the country working to strengthen sexuality education. Our work has never been more important or needed.

Jamie and I spent about 90 minutes Tuesday afternoon on ESSA. We introduced the federal legislation, including key Titles for those unfamiliar with it, shared Cairn Guidance's State ESSA Analysis, and allowed district participants time to review their states' analysis to determine opportunities and challenges within their districts as they move ahead. Yesterday, we spent the morning on WSCC- introducing the framework, sharing effective practices around the school health approach, systems thinking; systems changing, creating buy-in and addressing resistance and brought participants through a variety of engaging activities in order for districts to essentially begin to see how ESSA and WSCC, advocacy, support, implementation are feasible and achievable at home!

We created and share our ESSA/WSCC Symbaloo page- a page that showcases the most current, helpful resources in the school health field. Feel free to share with your colleagues.

We were honored to have the chance to network, socialize, share, train education leaders around the country this week- what a fabulous group truly dedicated to shifting the norms of how we define school success in the United States.

Since 2013, the Urban School Wellness Coalition brings together urban district health and wellness leaders to facilitate discussion around mutually important issues, provide opportunities to share information, network with peers, coordinate joint efforts, and inform urban educational leaders on the importance of student health as a driver of academic success. 

Skills based health education has been around for years but has really gained support and steam over the last few years. Many state, district, and national conventions are hosting presentations that focus on integrating skills based health. Classrooms are shifting from “let’s do a fun project” to “let’s do a fun project that allows students to practice a skill aligned to content that will promote health literacy.” Simple projects, lessons that are embedded in PE or other content areas, or lessons that are done sporadically throughout the year do a good job with presenting what students should know, the what of the lesson. In order to develop health literacy, we also need to share the why and how. Why do they need to know this information and skill and how does it connect to wellness? What are you going to do with the information and how does it support a lifetime of health literacy?

Many teachers were trained on basic health topics and how to teach those independent topics. We know students learn best when they are shown the bigger picture of health (holistic approach) and how all aspects of health are connected. Shifting the classroom focus to skills based health isn’t difficult, the students will still be learning familiar topics. The difference is now the lesson will focus on a skill while teaching the content. Students will be learning about decision making while learning nutrition content, accessing information and mental health, analyzing influences and drug prevention, or one of the other skills with a content that has been identified by your state or local school system.

There are many resources available to teachers to support them shifting to a skills based health classroom.I suggest reading these two books:“Skills Based Health Education” by Mary Connolly and

And, SHAPE America has been adding resources to the health education teacher’s toolbox.

RMC Health, located in Colorado, is another great resource that supports quality health education. From their website, “RMC Health has promoted the health and success of children and youth across the United States, and helped to transform the organizations that support them.” RMC Health has created skills based health models that provide guidance and skill cues by grade band/span. These health skills models have resources on how to teach the skills effectively to students.

Remember to always teach your local and state requirements. You don’t want to teach something that could get you fired or removal of your teaching certificate. Many requirements can be adjusted to address skills. If you know your curriculum, use CDC's Health Education Curriculum Analysis Tool (HECAT) to evaluate your information to see if you are covering items that CDC believes is critical to health education. The HECAT shares outcomes that students should reach based on grade bands/spans. The outcomes are divided into the National Health Education Standards. A teacher can identify a topic they want to teach (tobacco prevention), identify the grade band (6-8), identify the skill (accessing information), and then identify an outcome that matches their local curriculum (access valid and reliable tobacco-related prevention and cessation information from home, school, or community.) I might replace tobacco with nicotine because of vaping and e-cigarette use. I would use: “Access valid and reliable nicotine-related prevention and cessation information from home, school, or community.”

For example, when a health literate person accesses valid and reliable information, we want them to identify sources of health information, explain how to find the source, and explain why it’s a good source. For example, RMC Health has identified six steps to access reliable information:

How do you “Analyze for Validity” or “Analyze for Reliability”? RMC Health has a resource students and teachers can use to evaluate websites here. Librarians at CSU Chico created a tool called the CRAAP for evaluating resources. CRAAP stands for Currency, Relevance, Authority, Accuracy, and Purpose.

Health on the Net has been evaluating health information on websites for twenty years. They have a search tool individuals can use to locate valid and reliable information. The site is designed to support patients/individuals, medical professionals, or web publishers. Anyone can access the resources on their site. The site also shares the tool they use to evaluate information and students can use the tool to evaluate a website.

Health on the Net also create a quick guide on eight questions a person should think about when accessing a website.

The lesson will ask students to look for nicotine prevention and cessation services and evaluate those resources with one of the tools the teacher selects. What will the student with that information? The students could simply create a list of quality resources. Is that very engaging for your students? Does creating a list engage higher order thinking skills? If your school is tech focused, you could use google maps to pin key locations in the community. Students could also identify the barriers to health on that same map. Our main goal is to have them analyze these sites and identify ones that would provide valid and reliable information. Both of these activities meet that original objective. Should we provide a more engaging environment though? Students could work on advocacy by developing resources to be distributed at the local health department, hospital, clinic, PTA meeting, or health fair. This lesson could connect to environmental literacy by researching high pollution points of cigarette butts or vaping devices and organizing a student service project to clean up the area. Once the locations are identified, receptacles could be placed with signs about quitting smoking.

Skills based health education means students are practicing skills and learning how to apply those skills in multiple settings. Teachers need to introduce the skill, allow students to practice the skill with multiple content areas, and then allow the students to be given a scenario where they have to identify the skills to use and successfully apply those skills. Then with any skill, those skills must be practiced over time. We all know having healthy citizens makes our communities and businesses more productive and better places to live.

I have always worked in a job dedicated to service to others that is mission-driven. Here at Cairn Guidance, our mission is to create places of health and well-being where all youth are healthy, connected, educated and reaching their full potential. I’m willing to bet most people would agree this is a shared value. But how we get there is where we see so much divergence.

Most young people will have sex before they are married. Regardless of whether you talk about it or not, young people will have sex before they graduate high school. Nearly half (41%) of high schoolers in the US have had sex.[1]

The teen pregnancy rate has been dropping for years. While rates of sexual activity have been stable, the teen birth rate has dropped precipitously for years. So what has changed? Studies point to increased use of contraception, including more effective methods like long acting reversible contraceptives (LARCs).[2] The American Academy of Pediatrics put out a policy statement in 2014 recommending LARCs as the first line contraceptive choice for youth who choose not to be abstinent. Another policy support- the Affordable Care Act required that insurance companies cover contraceptives like LARCs to make them more accessible and lessen the burden on publicly funded family planning programs.

Learning to navigate relationships, intimacy and romance is part of growing into an adult. Being in a healthy relationship takes skills and skills take practice. Plus, too many young people find themselves in unhealthy relationships that can derail their potential. Many of the programs funded through the Office of Adolescent Health focused on helping young people identify healthy relationships, including consent and how to make healthy choices aligned with their values. Quality comprehensive sexuality education covers healthy relationships (including consent and how to get help if you are in an unhealthy relationship); abstinence as a healthy choice for our young people, contraception and building skills (like communication and negotiation). However, many young people in schools across our country do not have access to comprehensive sexuality education.

We have too far to go to head in the opposite direction. Even as teen pregnancy rates declined for all populations, there are still differences based on race and class that must be addressed. At least 1 in 5 women are sexually assaulted while in college. Young people must have access to information, health services, and opportunities to develop skills to keep themselves safe, healthy and able to learn.